Lumbar Spine - not to miss following points during examination

Contour

paraspinous muscles

 Errector Spinae or
 
 Sacrospinalis - Multifidus , Longissimus , Iliocostalis from medial to lateral

Symmetry

Pelvic Obliquity

Step off deformity

  Spondylolisthesis - body of involved vertebrae and rest of spine above slide forward

Lateral - Normal lordosis ,

                hyperlordosis - flexion contracture of hip

              flat back syndrome

                       compression fracture of lumbar vertebrae

               Gibbus - - sharp angular kyphosis kyphotic deformity

                              TB

Gait - antalgic

heel walk - 10 steps ,  L4 testing at L 3-4

toe walking

L5 - S1 testing

ROM - flexion 80- 90 , 10 cm to floor

extension 20 - 30 degrees

 lateral bending - 20 to 30 degrees

 rotation - 30 to 40 degrees

measurement - Schober test


Palpation

spinous process

counting L4-5 , level of iliac crest

paraspinous muscles - tender , tone

posterior facet joints

muscle testing

         flexion - rectus abdominis ,

           extension - errector spinae

Neurological

sensory

motor

 L1 and 2 - Iliopsoas

L 3 - Quadriceps ,

L4 - DF Ankle

L 5- EHL , Gluteus Medius , EDC

S1 - Peronei

       Gluetal Maximus

          Gastrosoleus

Reflexes - Normal patellar tendon reflexe , L 4

             L 5 - TP , Medial Hamstring

              S 1 - Achilles Tendon


Nerve Tension

   SLR

   Lasegue's test - DF after lowering 10 degrees from pain illicited during SLR

   Slump - variant of lasegue's test at sitting fom sitting looking straight ahead

                  allow C and T  vertebrae to collapse then bend head

               SLR and DF

                opposite side

             patient tells the experience

              thenn extend neck which relieves pain

 Bowstring sign - to point of repreoduction of pain , knee flexed

                            compress nerve on popliteal fossa

                            sensitivity 0.69 like lasegue's

Femoral Nerve Hyperextension test

Valsalva - Bearing down repoduces pain

Lumbar disc

 pain worsens with flexion

as opposed to spondylosis and spondylolisthesis

 no step off deformity